Utilising telehealth to support exercise and physical activity in people with Parkinson disease: a program evaluation using mixed methods

Background Physical activity and exercise play a key role in managing Parkinson disease. This study aimed to: 1) determine if physiotherapy supported by telehealth helped people with Parkinson disease (PwP) to adhere to a home-based exercise program and maintain their physical activity; and 2) understand their experiences of using telehealth during the COVID-19 pandemic. Methods A mixed methods program evaluation involving a retrospective file audit from a student-run physiotherapy clinic and semi-structured interviews exploring participants’ experiences of telehealth. Ninety-six people with mild to moderate disease received home-based telehealth physiotherapy for 21 weeks. The primary outcome was adherence to the prescribed exercise program. Secondary outcomes were measures of physical activity. Interviews were conducted with 13 clients and seven students and analysed thematically. Results Adherence to the prescribed exercise program was high. The mean (SD) proportion of prescribed sessions completed was 108% (46%). On average clients spent 29 (12) minutes per session, and 101 (55) minutes per week exercising. Physical activity levels were maintained, with clients taking 11,226 (4,832) steps per day on entry to telehealth, and 11,305 (4,390) steps per day on exit from telehealth. The semi-structured interviews identified important features of a telehealth service required to support exercise; a flexible approach of clients and therapists, empowerment, feedback, a therapeutic relationship, and mode of delivery. Conclusions PwP were able to continue exercising at home and maintain their physical activity when physiotherapy was provided via telehealth. The flexible approach of both the client and the service was imperative. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-023-09194-0.


Big step using visual cues -Warm up
Client`s aim To improve your ability to take big steps.

Client`s instructions
Position yourself in standing with two markers indicating the size of the step required ( 40 cm apart).
Step forward so that you step over both markers.

Bilateral calf raises -Warm up
Client`s aim To strengthen your calf muscles.

Client`s instructions
Position yourself standing with your feet together. Start with your heels on the ground. Finish with your heels off the ground.

Stand up and sit down -Warm up
Client`s aim To improve your ability to balance while standing up and sitting down . Client`s instructions Position yourself sitting with your toes under your knees. Practice standing up and sitting down. Ensure that your shoulders and knees move forward quickly to stand up and stick your bottom out to sit down. Ensure you stand all the way up and sit all the way down.

4.
Step on spot with high knees using visual cues -Warm up Client`s aim To improve your ability to lift the knees up and balance.

Client`s instructions
Position yourself in standing with targets at hip height, on a wall in front of you. March on the spot touching your knees to the targets. Ensure you stand up tall.

Client`s aim
To improve your ability to turn and reach in multiple directions.

Client`s instructions
Position yourself in front of a wall, standing holding a ball. Turn from side to side, stretching so that the ball touches the wall. Then, reach up to touch the wall above your head and squat down to touch wall between your feet.

Repeat 10 times in each direction
Do NOT perform reaching to the ground 6. Walk with big steps and big arms Client`s aim To improve your ability to walk with big steps and big arm movements simultaneously .

Client`s instructions
Hold a piece of ribbon in each hand. Walk forward with big steps, swinging the arms as high as possible with each step, i.e., exaggerate your arm swing while walking.
Step up Client`s aim To improve your ability to step up and balance.

Client`s instructions
Position yourself in standing with a block in front of you, both feet on the ground and a stable support nearby. Practice stepping up on to and off the block, one foot at a time. Ensure that hand support is used only if you feel unsteady.

Client`s aim
To improve your ability to turn on the spot . Client`s instructions Position yourself in standing and begin stepping on the spot. Then, keep stepping while turning 180 degrees. Repeat in the opposite direction. Aim for 4 steps for a full 180 degree turn. Ensure your steps are high enough to clear the ground.

Repeat 5 times in each direction
Make sure you perform this next to something stable 9.
Step over an obstacle Client`s aim To improve your ability to step over obstacles and balance.

Client`s instructions
Position yourself standing with an obstacle on the floor in front of you and stable support nearby. Practice taking a big step over the obstacle and shift your weight onto your forward leg, before stepping back. Ensure that hand support is used only if you feel unsteady.

10.
Step sideways over an obstacle Client`s aim To improve your ability to step over obstacles and balance. Client`s instructions Position yourself standing with an obstacle on the floor beside you and stable support nearby. Practice taking a big step sideways over the obstacle and transfer your weight onto the stepping leg before stepping back. Ensure that hand support is used only if you feel unsteady.

Please record time in minutes and type of other exercise
• Other exercise could include gardening, walking, cycling for example • Need to be in bouts of 10 minutes or more